The patient in question is a well-appearing male who makes poor eye contact but is ambulating without difficulty in the triage bay. “You know he has autism, and so it’s hard to tell sometimes what is wrong,” she continues. “But he is just not himself.” That explains why you are giving me the history, I think. But OK, I get it. The patient has some lower abdominal, R flank and RLQ pain without guarding but is not in any distress. He has vomited once today and maybe has been sick for a day or two (not clear). Vitals are normal.
This case also illustrates the communication barriers and challenge of patients with developmental impairment in the ED. Adults with autism, MR and behavioral problems can be difficult to assess in the case of suspected abdominal pathology (not to mention just about everything else). Make full use of the family, who know the quirks of their loved ones, and have a low threshold for more serious illness or injury.